I 

114TH CONGRESS 

1ST SESSION H. R. 4055 

To amend title IV of the Social Security Act to address the increased burden 

that maintaining the health and hygiene of infants and toddlers places 

on families in need, the resultant adverse health effects on children 

and families, and the limited child care options available for infants 

and toddlers who lack sufficient diapers, which prevents their parents 

and guardians from entering the workforce. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 18, 2015 

Mr. ELLISON (for himself, Ms. DELAURO, Mr. GRIJALVA, Mr. PETERS, Mr. 

CA ́RDENAS, Mr. CARSON of Indiana, Mr. MCGOVERN, Ms. MENG, Ms. 

CLARKE of New York, Ms. LEE, Mr. POCAN, Ms. KAPTUR, Ms. NORTON, 

Mr. NADLER, Mr. HASTINGS, Mr. CONYERS, Ms. MICHELLE LUJAN

GRISHAM of New Mexico, Ms. JUDY CHU of California, Ms. EDWARDS, 

and Mr. VAN HOLLEN) introduced the following bill; which was referred 

to the Committee on Ways and Means 

A BILL 

To amend title IV of the Social Security Act to address 

the increased burden that maintaining the health and 

hygiene of infants and toddlers places on families in 

need, the resultant adverse health effects on children 

and families, and the limited child care options available 

for infants and toddlers who lack sufficient diapers, 

which prevents their parents and guardians from entering the workforce. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Hygiene Assistance 

5 for Families of Infants and Toddlers Act of 2015’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Access to a reliable supply of clean diapers 

9 is a medical necessity for the health and welfare of 

10 infants and toddlers, their families, and child care 

11 and health care providers, yet in a representative 

12 survey of mothers in the United States, 1 in 3 moth13 ers reported having to cut back on essentials in 

14 order to afford enough diapers for a child. 

15 (2) In the United States, most children begin 

16 toilet training between 2 and 3 years of age, and 

17 after toilet training is complete, the child will not 

18 need diapers. Families with infants and toddlers are 

19 more likely to be economically disadvantaged than 

20 other families. Infants and toddlers are more likely 

21 to live with low-income and poor families than older 

22 children, 25 percent of infants and toddlers live with 

23 families earning less than the Federal poverty level, 

24 and 47 percent of infants and toddlers live with fam25 ilies earning less than twice the Federal poverty 


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1 level. There are over 980,000 infants and toddlers 

2 who are recipients of assistance under the program 

3 of block grants to States for temporary assistance 

4 for needy families (TANF), over one-third of all 

5 families enrolled in such a State program include an 

6 infant or toddler, and the average monthly diaper 

7 bill of $70 to $80 represents at least 8 percent and 

8 up to 40 percent of the average amount of cash as9 sistance provided to a family through such a State 

10 program. 

11 (3) The average monthly diaper bill of $70 to 

12 $80 represents 6 percent of the pretax income of a 

13 parent working full time for Federal minimum wage. 

14 Approximately 46 percent of low-income children 

15 and 26 percent of poor infants and toddlers live with 

16 at least 1 parent who is employed full time and year 

17 round, and only 47 percent of low-income children 

18 and 35 percent of poor infants and toddlers live with 

19 married parents. 

20 (4) Without child care, parents and guardians 

21 of infants and toddlers cannot participate in the 

22 workforce, but most child care providers require par23 ents to provide a supply of clean disposable diapers 

24 for their children. In a 2014 survey of 1,129 clients 

25 of 8 large diaper banks conducted by the National 


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1 Diaper Bank Network, 12.4 percent of respondents 

2 indicated that the respondent was unable to leave a 

3 child at a child care provider at least 1 day a month 

4 because the respondent’s child lacked diapers, and 

5 47.5 percent of respondents said that the diapers re6 ceived from the diaper bank enabled the respondent 

7 to go to work. Therefore, increasing availability of 

8 clean diapers for needy infants and toddlers furthers 

9 the national goal of enabling parents to participate 

10 in the workforce to increase their economic self-suffi11 ciency, and enables better implementation of title I 

12 of the Personal Responsibility and Work Oppor13 tunity Reconciliation Act of 1996. 

14 (5) Increasing the availability of clean diapers 

15 for needy infants and toddlers furthers the national 

16 goal of increasing access to safe and quality child 

17 care for all families, and therefore enables better im18 plementation of the Child Care and Development 

19 Block Grant Act of 1990. 

20 (6) Insufficient diaper changes can lead to not 

21 only increased irritability and discomfort of a child, 

22 leading to increased parental stress, but also to dia23 per dermatitis, skin breakdown, open sores with a 

24 risk of infection, and urinary tract infections for the 

25 child, which require medical attention. In a survey 


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1 commissioned by Feeding America in 2011, 48 per2 cent of food bank clients surveyed said they would 

3 delay changing a diaper and 32 percent said they 

4 would reuse disposable diapers in order to make 

5 their diaper supply last longer. This increases the 

6 risk of negative health outcomes for children and 

7 their families. 

8 (7) A study from the Yale School of Medicine 

9 found a direct correlation between lacking enough 

10 clean diapers to change a child’s diapers as often as 

11 required—a condition called ‘‘diaper need’’—and 

12 maternal depression, which can adversely affect ma13 ternal-child bonding, a mother’s ability to care for 

14 her child, and a mother’s ability to work outside the 

15 home. 

16 (8) Diapers have proven to be valuable incen17 tives in smoking cessation programs, parenting 

18 training programs, and other programs promoting 

19 positive and healthy behaviors. 

20 (9) Increasing the availability of clean diapers 

21 for needy families furthers public health by pro22 viding improved health outcomes for children, reduc23 ing visits to the emergency room, and reducing pa24 rental stress and depression. 


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1 SEC. 3. IMPROVING OPPORTUNITY DIAPER DEMONSTRA2 TION PROJECT. 

3 (a) IN GENERAL.—Section 403 of the Social Security 

4 Act (42 U.S.C. 603) is amended by adding at the end the 

5 following: 

6 ‘‘(c) DIAPER BENEFIT DEMONSTRATION PROJECT.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall make 

8 grants to States to conduct demonstration projects 

9 to implement and evaluate strategies to help families 

10 with eligible children address the diapering supply 

11 needs of such children. 

12 ‘‘(2) APPLICATION REQUIREMENTS.—A State 

13 desiring a grant under this subsection shall submit 

14 to the Secretary an application that includes the fol15 lowing: 

16 ‘‘(A) A description of how the State will 

17 use the grant funds to develop a diaper dis18 tribution program that will provide sufficient 

19 diapers and diapering supplies to each partici20 pating family so that each eligible child in the 

21 family receives, for each month in which the 

22 child participates in the program, not less than 

23 the lesser of— 

24 ‘‘(i) 50 percent of the diaper changes 

25 required for a month for a healthy child of 

26 similar age and size; or 


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1 ‘‘(ii) 100 percent of the actual diaper 

2 changes required for the child for the 

3 month. 

4 ‘‘(B) A description of how the State will 

5 coordinate with other State and Federal assist6 ance programs and agencies (particularly other 

7 programs and agencies targeted at assisting in8 fants, toddlers, or the parents or guardians of 

9 infants or toddlers) that provide benefits and 

10 services to families participating in the diaper 

11 distribution program, to integrate the distribu12 tion of diapers and diapering supplies with the 

13 delivery of such other benefits and services, for 

14 the purpose of— 

15 ‘‘(i) helping participating families to 

16 use effectively the benefits they receive 

17 under the diaper distribution program; and 

18 ‘‘(ii) removing barriers to the partici19 pation of such families in activities such as 

20 child care, training, and work activities. 

21 ‘‘(C) A description of how the State will 

22 evaluate the extent to which the diaper distribu23 tion program increases the efficacy, and affects 

24 the participation rates, of other State and Fed25 eral assistance programs in the State. 


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1 ‘‘(D) A description of how the State will 

2 provide for the delivery of benefits under the di3 aper distribution program, which may include— 

4 ‘‘(i) cash assistance to be used to pur5 chase diapers and diapering supplies; 

6 ‘‘(ii) vouchers, coupons, electronic 

7 benefit transfer systems, or any other non8 cash method to be used to purchase dia9 pers and diapering supplies, except that 

10 the State may not require a store to cover 

11 the cost of any equipment, system, or proc12 essing required for any such method as a 

13 condition of participation in the program; 

14 ‘‘(iii) assistance in distributing dia15 pers and diapering supplies from any pro16 gram or agency the State considers appro17 priate, which may include— 

18 ‘‘(I) State or Federal child care 

19 programs; 

20 ‘‘(II) work programs or father21 hood initiative programs, if the State 

22 explains the method it intends to use 

23 to ensure that diapers and diapering 

24 supplies distributed through these 


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1 programs are used by the eligible 

2 child who is the intended recipient; 

3 ‘‘(III) home visiting programs; 

4 ‘‘(IV) family resource centers; 

5 ‘‘(V) Federal and State health 

6 clinics; and 

7 ‘‘(VI) community service centers; 

8 ‘‘(iv) the distribution of diapers and 

9 diapering supplies at diaper banks or 

10 through other nonprofit organizations de11 scribed in section 501(c)(3) of the Internal 

12 Revenue Code of 1986 and exempt from 

13 taxation under section 501(a) of such 

14 Code, including through the assistance of 

15 other State or Federal agencies that part16 ner with such organizations to assist with 

17 diaper and diapering supply distribution; 

18 and 

19 ‘‘(v) the distribution of diapers and 

20 diapering supplies at any other location or 

21 through any other means that will allow 

22 the State to deliver diapers and diapering 

23 supplies to participating families without 

24 undue inconvenience. 


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1 ‘‘(E) A description of whether the State 

2 will provide a cloth diapering system, a dispos3 able diapering system, or both, and in cases in 

4 which the State provides a cloth diapering sys5 tem, an explanation of how the State will pro6 vide for diaper cleaning services if requested by 

7 the parent or guardian. 

8 ‘‘(F) A description of how the State will 

9 ensure that the diapering system or systems 

10 provided meet the requirements of licensed child 

11 care facilities in the State, such that the type 

12 of diapers and diapering supplies provided do 

13 not prevent participating families from enrolling 

14 eligible children in such a facility. 

15 ‘‘(3) USE OF FUNDS.—A State to which a grant 

16 is made under this subsection shall use the grant 

17 funds to carry out a diaper distribution program in 

18 accordance with the State grant application ap19 proved by the Secretary, as provided in paragraph 

20 (2). 

21 ‘‘(4) PROGRAM ADMINISTRATION.— 

22 ‘‘(A) STATE TANF AGENCY AS PRIMARY

23 ADMINISTRATOR.—Subject to subparagraph 

24 (B), a State diaper distribution program carried 

25 out pursuant to this subsection shall be carried 


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1 out by the State agency responsible for admin2 istering the State program funded under this 

3 part. 

4 ‘‘(B) AUTHORITY TO SUBGRANT AND COL5 LABORATE.—In carrying out such diaper dis6 tribution program, the State agency described 

7 in subparagraph (A) may collaborate with, and 

8 the State may make a subgrant to, such public 

9 and nonprofit entities as the State considers ap10 propriate, including State agencies, local gov11 ernments, community-based organizations, 

12 Community Action Agencies, child care agen13 cies, food assistance agencies, and other non14 profit organizations described in section 

15 501(c)(3) of the Internal Revenue Code of 1986 

16 and exempt from taxation under section 501(a) 

17 of such Code. 

18 ‘‘(5) CERTIFICATION OF BENEFIT ELIGI19 BILITY.—A State to which a grant is made under 

20 this subsection may require, as a condition of receiv21 ing benefits under a State diaper distribution pro22 gram, that participating families provide to the 

23 State such information at such times as the State 

24 considers necessary to determine whether a child in 


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1 the family is (or continues to be) an eligible child, 

2 as such term is defined in paragraph (7)(D). 

3 ‘‘(6) REPORTS.—As a condition of receiving a 

4 grant under this subsection for a fiscal year, the 

5 State shall submit to the Secretary, not later than 

6 6 months after the end of the fiscal year, a report 

7 that— 

8 ‘‘(A) specifies the number of children and 

9 the number of families receiving assistance 

10 under the State diaper assistance program for 

11 each month of the fiscal year; 

12 ‘‘(B) specifies the number of cloth diapers, 

13 the number of disposable diapers, and the num14 ber of each type of diapering supply distributed 

15 under the diaper distribution program for each 

16 month of the fiscal year; 

17 ‘‘(C) specifies the method or methods the 

18 State uses to distribute diapers and diapering 

19 supplies; and 

20 ‘‘(D) specifies the number of children and 

21 the number of families receiving benefits under 

22 the diaper distribution program who also re23 ceive assistance during the fiscal year under 

24 other relevant public assistance programs, as 

25 determined by the Secretary. 


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1 ‘‘(7) EVALUATION.— 

2 ‘‘(A) IN GENERAL.—Not later than Sep3 tember 30, 2018, the Secretary, in consultation 

4 with each State that receives a grant under this 

5 subsection, shall conduct a high quality evalua6 tion of the effectiveness of the State diaper dis7 tribution programs carried out pursuant to this 

8 subsection and of varying approaches for dis9 tributing diapers and diapering supplies used in 

10 such State programs. 

11 ‘‘(B) AREAS OF EVALUATION.—The eval12 uation described in subparagraph (A) shall in13 clude a study of the populations served in such 

14 State programs, the different methods used by 

15 States to distribute diapers and diapering sup16 plies, and the effectiveness of each such meth17 od. 

18 ‘‘(C) EVALUATOR QUALIFICATIONS.—The 

19 Secretary may not enter into a contract with an 

20 evaluator to conduct an evaluation under this 

21 paragraph unless the evaluator has dem22 onstrated experience in conducting rigorous, de23 scriptive evaluations of program effectiveness. 

24 ‘‘(D) FINAL EVALUATION.—Not later than 

25 September 30, 2022, the Secretary, in consultaVerDate Sep 11 2014 22:08 Nov 21, 2015 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H4055.IH H4055

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1 tion with each State that receives a grant under 

2 this subsection, shall update the evaluation de3 scribed in subparagraph (A). 

4 ‘‘(E) REPORTS AND PUBLIC DISCLO5 SURE.— 

6 ‘‘(i) INITIAL REPORT.—Not later than 

7 September 30, 2018, the Secretary shall— 

8 ‘‘(I) submit to the relevant con9 gressional committees a report on the 

10 results of the evaluation described in 

11 subparagraph (A); and 

12 ‘‘(II) publish the results of the 

13 evaluation on the website of the De14 partment of Health and Human Serv15 ices in a location that is easily acces16 sible to the public. 

17 ‘‘(ii) FINAL REPORT.—Not later than 

18 90 days after completion of the final eval19 uation pursuant to subparagraph (D), the 

20 Secretary shall— 

21 ‘‘(I) submit to the relevant con22 gressional committees a report de23 scribing the results of the final eval24 uation; and 


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1 ‘‘(II) update the website de2 scribed in clause (i)(II) to include the 

3 results of the final evaluation. 

4 ‘‘(8) APPLICABILITY OF CERTAIN PROVI5 SIONS.— 

6 ‘‘(A) DIAPER BENEFITS NOT COUNTED AS

7 ASSISTANCE.—Benefits provided under a State 

8 diaper distribution program conducted pursuant 

9 to this subsection shall not be counted as assist10 ance under a State program funded under this 

11 part (or any other State program funded with 

12 qualified State expenditures (as defined in sec13 tion 409(a)(7)(B)(i))). 

14 ‘‘(B) RULES CONCERNING GRANTS INAP15 PLICABLE.—Sections 404 and 409(a)(4) shall 

16 not apply with respect to a grant made under 

17 this subsection. 

18 ‘‘(9) REGULATIONS.—The Secretary of Health 

19 and Human Services may prescribe such regulations 

20 as may be necessary to implement this subsection. 

21 ‘‘(10) DEFINITIONS.—In this subsection: 

22 ‘‘(A) The term ‘diaper’ means an absorb23 ent garment that is washable or disposable that 

24 is worn by a child who cannot control bladder 

25 or bowel movements. 


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1 ‘‘(B) The term ‘diapering supplies’ means 

2 items, including diaper wipes and diaper cream, 

3 necessary to ensure that a child using a diaper 

4 is properly cleaned and protected from diaper 

5 rash, and that the surrounding population is 

6 protected from harmful bacteria originating 

7 from dirty diapers. 

8 ‘‘(C) The term ‘diapering system’ means a 

9 method of providing an adequate supply of 

10 clean, properly sized diapers and diapering sup11 plies. In the case of washable cloth diapers, this 

12 method includes the laundering of diapers to 

13 ensure a sufficient supply of clean diapers and 

14 waterproof covers. 

15 ‘‘(D) The term ‘eligible child’ means a 

16 child who— 

17 ‘‘(i) is not toilet-trained; 

18 ‘‘(ii) has not attained 3 years of age, 

19 unless the State determines that the child 

20 has a substantial physical or mental im21 pairment that requires the child to wear 

22 diapers; and 

23 ‘‘(iii) is— 

24 ‘‘(I) a recipient of, or is eligible 

25 to receive, assistance under a State 


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1 program funded under this part (or 

2 any other State program funded with 

3 qualified State expenditures (as de4 fined in section 409(a)(7)(B)(i))), or 

5 is a member of a family that meets 

6 the income eligibility requirements of 

7 such State program; or 

8 ‘‘(II) a member of a family whose 

9 income is not more than 130 percent 

10 of the poverty line (as defined by the 

11 Office of Management and Budget, 

12 and revised annually in accordance 

13 with section 673(2) of the Omnibus 

14 Budget Reconciliation Act of 1981) 

15 applicable to a family of the size in16 volved. 

17 ‘‘(E) The term ‘infant’ means a child who 

18 has not attained 1 year of age. 

19 ‘‘(F) The term ‘participating family’ 

20 means a family that includes an eligible child 

21 participating in a State diaper distribution pro22 gram carried out pursuant to this subsection. 

23 ‘‘(G) The term ‘State’ means each of the 

24 50 States, the District of Columbia, Puerto 

25 Rico, Guam, the United States Virgin Islands, 


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1 the Northern Mariana Islands, American 

2 Samoa, and Indian tribes and tribal organiza3 tions. 

4 ‘‘(H) The term ‘toddler’ means a child who 

5 has attained 1 year of age but has not attained 

6 3 years of age. 

7 ‘‘(I) The term ‘toilet-trained’ means able 

8 and willing to use a toilet consistently such that 

9 diapers are not necessary on a daily basis. 

10 ‘‘(11) APPROPRIATION.—Out of any funds in 

11 the Treasury of the United States not otherwise ap12 propriated, there are appropriated for each of fiscal 

13 years 2017 through 2021 $75,000,000 to carry out 

14 this subsection. 

15 ‘‘(12) AVAILABILITY OF FUNDS.—Funds pro16 vided to a State under this subsection for a fiscal 

17 year may be expended only in the fiscal year or the 

18 succeeding fiscal year.’’. 

19 (b) DIAPER BENEFITS EXEMPTED FROM TERRI20 TORIAL PAYMENT CEILING.—Section 1108(a)(2) of such 

21 Act (42 U.S.C. 1308(a)(2)) is amended by inserting 

22 ‘‘403(c),’’ after ‘‘403(a)(5),’’. 

Æ 


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